Healthcare Provider Details

I. General information

NPI: 1245669589
Provider Name (Legal Business Name): TODD JAMES MIEHLKE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W GRAND RIVER AVE
OKEMOS MI
48864-1706
US

IV. Provider business mailing address

15023 DUXBURY LN
LANSING MI
48906-9321
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-9133
  • Fax: 517-347-9165
Mailing address:
  • Phone: 517-290-3138
  • Fax: 517-347-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number411208
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: